Velmeden David, Söhne Jakob, Schuch Alexander, Zeid Silav, Schulz Andreas, Troebs Sven-Oliver, Müller Felix, Heidorn Marc W, Buch Gregor, Belanger Noémie, Dinh Wilfried, Mondritzki Thomas, Lackner Karl J, Gori Tommaso, Münzel Thomas, Wild Philipp S, Prochaska Jürgen H
Preventive Cardiology and Preventive Medicine, Department of Cardiology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main Mainz Germany.
J Am Heart Assoc. 2025 May 20;14(10):e039792. doi: 10.1161/JAHA.124.039792. Epub 2025 May 15.
Cardiac autonomic dysfunction is associated with heart failure (HF). Reduced heart rate recovery (HRR) indicates impaired parasympathetic reactivation after physical activity. Heart rate recovery 60 seconds after peak effort (HRR) is linked to autonomic dysfunction, but data on its relevance across HF phenotypes are scarce. This study aimed to identify clinical determinants of HRR in an HF cohort and assess its relationship with clinical outcomes.
Data from the MyoVasc study (NCT04064450; N=3289) were analyzed. Participants underwent standardized clinical phenotyping including cardiopulmonary exercise testing. HRR was defined as the heart rate decline 60 seconds after exercise termination. Clinical determinants of HRR were evaluated using multivariate regression, whereas Cox regression analyses assessed all-cause death and worsening of HF.
The analysis sample comprised 1289 individuals (median age, 66.0 [interquartile range {IQR}, 58.0-73.0] years, 30.4% women) ranging from stage B to stage C/D according to the universal definition of HF. Age, sex, smoking, obesity, peripheral artery disease, and chronic kidney disease were identified as determinants of HRR. HRR showed a strong association with all-cause death (hazard ratio [HR], 1.56 [95% CI, 1.32-1.85]; <0.0001) and worsening of HF (HR, 1.36 [95% CI, 1.10-1.69]; =0.0052) independent of age, sex, and clinical profile. Sensitivity analysis showed a stronger association with worsening HF in HF with preserved left ventricular ejection fraction (=0.027).
HRR was associated with clinical outcome in chronic HF. Because it showed a stronger association with outcomes in HF with preserved ejection fraction, future research should consider phenotype-specific differences.
心脏自主神经功能障碍与心力衰竭（HF）相关。心率恢复（HRR）降低表明体力活动后副交感神经再激活受损。运动峰值后60秒的心率恢复（HRR）与自主神经功能障碍有关，但关于其在不同HF表型中的相关性的数据很少。本研究旨在确定HF队列中HRR的临床决定因素，并评估其与临床结局的关系。
分析了MyoVasc研究（NCT04064450；N = 3289）的数据。参与者接受了标准化的临床表型分析，包括心肺运动测试。HRR定义为运动终止后60秒的心率下降。使用多变量回归评估HRR的临床决定因素，而Cox回归分析评估全因死亡和HF恶化情况。
分析样本包括1289名个体（中位年龄66.0岁[四分位间距{IQR}，58.0 - 73.0岁]，30.4%为女性），根据HF的通用定义，其病情从B期到C/D期不等。年龄、性别、吸烟、肥胖、外周动脉疾病和慢性肾病被确定为HRR的决定因素。HRR与全因死亡（风险比[HR]，1.56[95%置信区间，1.32 - 1.85]；<0.0001）和HF恶化（HR，1.36[95%置信区间，1.10 - 1.69]；=0.0052）密切相关，且独立于年龄、性别和临床特征。敏感性分析显示，在左心室射血分数保留的HF中，HRR与HF恶化的关联更强（=0.027）。
HRR与慢性HF的临床结局相关。由于它在射血分数保留的HF中与结局的关联更强，未来的研究应考虑表型特异性差异。
